Building Partnerships to Foster Community Preparedness in
Vulnerable Populations
An Outreach Initiative to Administrations within DHMH
and their Constituents
PHASE Symposium
May 9th, 2014
Presented by: Shini Tsai, Pharm.D.
Preceptor: Artensie Flowers, Ph.D., MPH
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Maryland Department of Health and Mental Hygiene
Outline
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Public Health Preparedness and Response
Maryland Office of Preparedness and Response (OP&R)
National Health Security Preparedness Index (NHSPI)
Vulnerable Populations
Outreach Initiative
Opportunities/Challenges
Conclusion
Questions
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Maryland Department of Health and Mental Hygiene
What is Public Health Preparedness ?
“… capability of the public health and healthcare systems,
communities, and individuals, to prevent, protect against,
quickly respond to, and recover from health emergencies,
particularly those whose scale, timing, or unpredictability
threatens to overwhelm routine capabilities.”
(Gibson, P. et al. 2012)
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Maryland Department of Health and Mental Hygiene
Types of Emergencies
 Natural disasters
 Inclement weather
 Earthquakes,
 Volcanic eruption, etc.
 Medical emergencies
 Pandemics
 Disease outbreaks
 Bioterrorism
 Public Safety
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Terrorism
Drug and product recalls
Supply shortages
Community threats
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Maryland Department of Health and Mental Hygiene
Maryland Office of Preparedness and
Response (OP&R)
 Office within DHMH that coordinates statewide preparedness
and response to public health- and natural emergencies
 Security and resilience of the State of Maryland
 DHMH Operations Center, State Emergency Operations
Center during major PH events
 Partnerships between public and private stakeholders
 Planning, training, coordination of resources
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Maryland Department of Health and Mental Hygiene
OP&R Preparedness and Response
(continued…)
 Hospital Preparedness Program (HPP)
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Funding from ASPR to DHMH to improve health systems readiness
Technical and administrative support to MD health systems
Increase surge capacity, exercises, drills, emergency protocols
Promote regional coalition between hospitals
• Public Health Emergency Preparedness (PHEP)
 Funding from CDC to DHMH to improve preparedness in community
 Technical and administrative support to LHDs
 Training, program evaluation, implementation and assistance
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Maryland Department of Health and Mental Hygiene
OP&R Preparedness and Response
(continued…)
 Strategic National Stockpiling (SNS):
 Coordinates SNS distribution exercises throughout the year
 City Readiness Initiative (CRI):
 Works with SNS to enhance readiness of cities to receive prophylactic
medication within 48 hours of event recognition
 MD Responds:
 Maryland’s volunteer Medical Reserve Corps
 Health System Surge Planning:
 Increases surge capacity by preventing depletion of resources
 Bio-Surveillance
 Training and Exercises
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Maryland Department of Health and Mental Hygiene
MD Statewide Public Health Risk
Assessment (PHRAT)
 Diverse geography in MD:
 Eastern shore: Low-lying coastal region, prone to storms
 Western MD: Rural, mountainous, prone to flooding & winter storms
 Central MD: Urban, industrial hub, prone to pandemics, terrorism
 Top 3 Hazards: Pandemics, utility interruption, floods
 Priorities:
 Community preparedness and recovery (planning, training, exercises)
 At-risk populations:
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Physical & mental & cognitive disability
Poverty & limited English proficiency
Children < 18 years & elderly ≥ 65 years
Chronic diseases
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Maryland Department of Health and Mental Hygiene
What is the National Health Security
Preparedness Index?(NHSPI™)?
A first of its kind tool to annually measure and advance
our preparedness
Examines health security preparedness of the nation by
collectively looking at states
Accurate portrayal of nation’s health security using data
to achieve a higher level of preparedness
Source: NHSPI. What is the National Health Security Preparedness Index? Power
Point 2013 [Image on the Internet] [cited 2014 May 5] Available at:
http://www.nhspi.org/content/briefing-slides
Maryland Department of Health and Mental Hygiene
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Who can use the NHSPI™?
Policymakers
Researchers and
Academics
Practitioners
Communicators
Source: NHSPI. What is the National Health Security Preparedness Index? Power Point 2013 [Image
on the Internet] [cited 2014 May 5] Available at: http://www.nhspi.org/content/briefing-slides
Maryland Department of Health and Mental Hygiene
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NHSPI™ (continued…)
 Why the NHSPI™?
 Standardized and most comprehensive way to measure preparedness
 Assess how well we are prepared on national level
 Guides improvement efforts via comparative national average
 How can we use the NHSPI™?
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Quality improvement
Collaboration/increase shared responsibility
Policy and resource direction- information, generates discussions
Advance preparedness science
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Maryland Department of Health and Mental Hygiene
NHSPI™ - Maryland
Domain & Subdomain
MD Score
Nat. Average
Health Surveillance
7.9
7.3
Incident & Information
8.6
7.7
Countermeasure
9.5
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Comm. Planning &
Engagement
6.2
6.1
Cross-Sector/Comm.
Collaboration
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5.9
At Risk Population
6.9
6.3
6.8
5.8
Acute & Primary Care
6.1
5.9
Emergency Medicine
9.1
6.6
Mental & Behavioral
Health
5.3
4.9
Surge Management
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Maryland Department of Health and Mental Hygiene
Opportunities: DHMH Offices and
Vulnerable Populations
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Women Children and Infant Program (WIC):
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Monthly WIC vouchers for nutritious supplementation of diet
> 10, 000 clinics nationwide; > 9.1 mio. women & children
OP & R can work to ensure continuity of services, if WIC vouchers
cannot be retrieved during emergencies
Office for Children & People with Special Healthcare Needs
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Children with genetic and debilitating diseases
Medical Homes:
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Children Medical Services (CMS):
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Partnerships between primary care physicians (PCP) and parents
Medical and emergency services for children 0-21 years
Cases need to be approved by CMS staff prior to utilization
OP &R can work with CMS staff and PCP to increase
preparedness and ensure access to medical services during
emergencies
Maryland Department of Health and Mental Hygiene
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Opportunities: DHMH Offices and
Vulnerable Populations (continued…)
 Office of Minority Health and Health Disparity:
 Health equity among minorities (African Americans, Asians,
Hispanic/Latino American, Native Americans)
 Improve access to healthcare for non-English speaking residents
 Health Enterprise Zones (HEZs)
 Primary care and essential health services to underserved (urban) communities
 Targets: Minorities/urban dwellers with chronic diseases and infections
 OP &R can work to ensure continuity of drug therapies
 Alcohol and Drug Abuse Administration:
 Substance abuse treatment programs in 24 MD jurisdictions
 Sudden treatment interruption can elicit deadly withdrawal
 OP & R can work with staff to improve access to communication with
ADAA centers.
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Maryland Department of Health and Mental Hygiene
Outreach Initiative
 Objectives:
 Improve emergency capability of DHMH administrations
 Promote self-sufficiency of DHMH programs during emergencies
 Enhance work relations with other DHMH offices by building and
strengthening partnerships and community engagement
 Goals:
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Improve state’s surge capacity by integrating preparedness planning
Increase resiliency of vulnerable populations
Increase Maryland’s NHSPI™
Prevent depletion of state’s emergency medical resources
Protect essential infrastructure during emergencies
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Maryland Department of Health and Mental Hygiene
Opportunities
 Strengthening work relations with DHMH offices:
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Promote role of OP&R within DHMH and in emergency planning
Learning about other DHMH offices and their projects
Identification of future areas of interest
Opportunities for networking and future collaboration
 Expanding DHMH services:
 Strengthening existing programs by including emergency preparedness
 Expanding DHMH programs to underserved/vulnerable populations
 Potential funding increase
 Strengthening vulnerable populations:
 Resiliency and self-sufficiency during emergencies
 Uninterrupted services during emergencies
 Decrease incidents of bodily harm due to sudden program interruptions
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Maryland Department of Health and Mental Hygiene
Opportunities (continued…)
 Promoting public health preparedness:
 Increase preparedness level of the State of Maryland
 Strengthening OP&R’s presence in the community
 Promote understanding and importance of being prepared
 Public Safety:
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Increase Maryland’s score on the NHSPI™
Improve Maryland’s access to emergency care
Avoiding depletion of essential resources
Prevent bodily injuries and mass casualty
Maintain secure environment by ensuring that residents can safely
remain at home
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Maryland Department of Health and Mental Hygiene
Challenges
 Training:
 Time:
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Must be convenient for audience and must be during normal business hours
Administrations may not be able to “spare” employees for training purposes
Should not be scheduled in the afternoon
Remote employees may not be able to attend
 Cost:
 Cost of training continuation on DHMH administrations
 Cost of attendees “hours of work missed”
 Cost of implementing OP&R’s recommendations
 Duration:
 Sessions must be brief (≤ 90 minutes)
 Session length will depend on target audience
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Maryland Department of Health and Mental Hygiene
Challenges (continued…)
 Venue:
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Location must be convenient and easily accessible for audience
Preference for location with access to public transportation
Adequate size to accommodate participants and provide workspace
May need advance booking
 Audience:
 Due to size of DHMH, identifying target audience is difficult
 Must be open to training, critique and collaboration
 Outreach:
 Lack of interest- must offer incentives or establish buy-in!
 Emails: Most efficient, but best way? What is best way of promoting?
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Maryland Department of Health and Mental Hygiene
Conclusion
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Opportunities:
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Promote and improve PH emergency among DHMH administrations
and the community by reaching out to vulnerable populations
Potential for project to grow outside of DHMH
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Future targets: Department of Education – school aged children
Department of Veterans’ Affairs
Limitations:
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Difficult to identify vulnerable populations and their respective
DHMH administrations –need DATA!
At the time of completion of PHASE internship, outreach and
training have not commenced
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Maryland Department of Health and Mental Hygiene
Questions and Comments
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Maryland Department of Health and Mental Hygiene
References:
Gibson, P. et al. The Common Ground Preparedness Framework: A Comprehensive Description of Public
Health Emergency Preparedness. American Journal of Public Health; April 2012, Vol 102 No 4: 633642
Office of Preparedness and Response. Department of Health and Mental Hygiene [Internet] [cited May
5th, 2014]. Available at: http://preparedness.dhmh.maryland.gov/aboutus/SitePages/Home.aspx
WIC. Department of Health and Mental Hygiene[Internet] [cited May 5th, 2014] Available at:
http://phpa.dhmh.maryland.gov/wic/SitePages/Home.aspx
Office for Children and People with Special Healthcare needs. Department of Health and Mental
Hygiene [Internet] [cited May 5th, 2014] Available at:
http://phpa.dhmh.maryland.gov/genetics/SitePages/Home.aspx
Office of Minority Health and Health Disparities. Department of Health and Mental Hygiene [Internet]
[cited May 5th, 201] Available at: http://dhmh.maryland.gov/mhhd/SitePages/Home.aspx
Office of Alcohol and Drug Abuse Administrations. Department of Health and Mental Hygiene [Internet]
[cited May 5th, 2014] Available at: http://adaa.dhmh.maryland.gov/SitePages/Home.aspx
Statewide Public Health Risk Assessment. Maryland Department of Health and Mental Hygiene. Issue
Brief. Univesity of Maryland Baltimore County and IFC International. Nov. 8th, 2013
NHSPI. What is the National Health Security Preparedness Index? Power Point 2013 [Internet] [cited
2014 May 5] Available at: http://www.nhspi.org/content/briefing-slidesn
CDC. Office of Public Health Preparedness and Response [Internet] [cited May 5th, 2014]. Available at:
http://www.cdc.gov/phpr/coopagreement.htm
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Maryland Department of Health and Mental Hygiene